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New Canada Food Guide: What does this mean if your gluten-free?

Health Canada released their new Food Guide recently with some key updates. The content was created using the most up to date and evidence-based research. In this food guide, there is a renewed focus on plant-based foods, lower intakes of processed foods which contain higher levels of sugar, saturated fat and sodium with less direct emphasis on dairy product as the dairy and meat categories were combined into one group labelled protein. The Food Guide also has a guiding statement that if Canadians have a specific health condition, such as celiac disease then they should consult further with a dietitian for their specific nutritional requirements.

Key nutrients, added fats and sugars must be managed

Folate

One of the first considerations includes the differences in folate fortification of gluten-free grains and processed grains which can result in lower folate intakes of children and adults with CD(1).  While folate fortification of gluten containing flours is mandatory in Canada, folate fortification of gluten-free flours and processed grains Is voluntary in Canada.  This places Canadians consuming the GFD at risk for suboptimal folate intake(1).  While the increasing emphasis of plant sources of protein (such as lentils, beans) and fruits and vegetable may be potentially beneficial to increasing folate intake in Canadians on the GFD, it will be challenging for children and woman of child-bearing potential with CD to eat sufficient quantities of these foods to meet their folate needs.  Suboptimal folate status has important growth and developmental implications for both the child and woman of child-bearing potential and hence needs to be addressed when developing nutrition guidelines for Canadians with CD.  Consultation with a registered dietitian regarding the need for routine folate supplementation is an important consideration for Canadians with CD and highlights the need for consideration of a folate fortification policy for gluten free grains in Canada.   Development of evidenced based nutrition guidelines for Canadians with CD will also be important in this process.

Vitamin D & calcium

Other nutrients of concern for children with CD are vitamin D and calcium.   Vitamin D is predominantly found in fatty fish, vitamin D fortified cow’s milk and fortified margarine.  Calcium can also be found in dairy products, some plant-based proteins and calcium-fortified plant foods. Vitamin D  and calcium are important nutrients for bone health, particularly at time of CD diagnosis due to the potential for malabsorption of vitamin D related to gastrointestinal damage caused by gluten exposure.  This is particularly important for children and youth as peak bone mass is achieved in adolescence and early adulthood. Vitamin D can also be obtained by exposure to sunlight as the sun stimulates the skin to produce and synthesize vitamin D.  However, as Canadians have reduced sunlight exposure due to our long winters, sub-optimal vitamin D status can occur throughout the year if Canadians do not consume sufficient quantities of vitamin D-fortified foods. As a Canadian with CD, it will be important to eat and drink sufficient quantities of vitamin D and calcium-rich foods and to consider the need for routine supplementation during the long winter months.  Choosing lower fat, dairy choices that are fortified with vitamin D and calcium fortified plant sources  will also be important for Canadians with CD to ensure they meet their vitamin D  and calcium needs.  


Lowering saturated fat and added sugars

Lastly, the final consideration of the new guidelines regarding lowering your intakes of saturated fat and added sugars is an important message for Canadians.  It is noteworthy to highlight that Health Canada is placing a stronger and more direct message regarding this point.  Increasing intakes of fruits and vegetables and lower fat dairy and meat and alternatives (protein choices) as a healthy way to accomplish this is being emphasized in the new guide.  However, for the child and adult with CD this can be challenging since many of the processed GF-grain products are a lot higher in saturated fat and added sugars.  A recent Canadian study by Elliot et al

has shown that gluten free foods marketed to children were higher in added fats and sugars.   This is particularly concerning for children and adults with CD as this may increase the risk for obesity and chronic diseases and thus highlights the need for nutrition guidelines to emphasize ways for Canadians with CD on the gluten free diet to address this.

Meeting nutritional needs on a GF diet

One of the ways is for specific evidenced-based nutrition guidelines focused on the GFD to be developed.  This is currently being done by a team lead by Dr Diana Mager PhD RD at the University of Alberta.    Currently Dr Mager and her team are developing a GF food guide for children and youth with CD and hope to extend this work in the future by developing a GF food guide for adults.   This endeavor is important because specific consideration of the nutritional challenges associated with eating a gluten free diet is being addressed in these guidelines.   This work has been supported by a Canadian Celiac Association J.A Campbell Research Award and with help from the Edmonton and Calgary Chapters of the Canadian Celiac Association.

For more information regarding Gluten Free Food Guide for Canadian Children and Youth, contact 

Dr Diana Mager PhD RD, Associate Professor, Clinical Nutrition, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton Alberta; mager@ualberta.ca

For more information regarding the folate and vitamin D content of foods, go to:

Canada’s food guide:

https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/resources-download.html

1.          Alzaben AS, Turner J, Shirton L, Samuel TM, Persad R, Mager D. Assessing Nutritional Quality and Adherence to the Gluten-free Diet in Children and Adolescents with Celiac Disease. Can J Diet Pract Res. 2015 Jun;76(2):56-63.

2.         Elliott C. The Nutritional Quality of Gluten-Free Products for Children. Pediatrics. 2018 Aug;142(2)

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